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The health reform debate may be reignited before the fall elections, after all.

Bloomberg and Roll Call are reporting that President Obama’s recess appointee to the Centers for Medicare and Medicaid Services, Dr. Don Berwick, will go to the Senate for confirmation after all. This is a huge switch, and it’s likely all about protecting the multi-year realization of the Affordable Care Act, aka health reform.

A political move? Pundits are noting that that this switch happened on the same day that the late Sen. Robert Byrd’s West Virginia Senate seat was filled with Democrat Carte Goodwin.
Given that the future control of both congressional houses could switch after the elections, it may well be safer for the future of health reform to put Berwick up for a vote now, as opposed to later, the pundits say.

But why is the amiable pediatrician, a man who has fought for years to make health care safer and more consumer-friendly, such a lightning rod for conservatives?

He admires the British national health system, and has long been an advocate for more science-based standardization in how medicine is practiced. He rails against the dehumanizing forces of big medicine, and insists on consumer-oriented openness.
It is Berwick’s group that deserves much of the credit for the on-line availability of data on hospital quality that consumers have access to today. His group pushed for standards that hospitals are now measured by Medicare on, such as whether they give aspirins to heart attack patients and appropriate antibiotics to surgical patients.

As the head of the Centers for Medicare and Medicaid Services, it has been noted, he will oversee a budget larger than the Pentagon’s.

Expect him to go much farther in transforming how Medicare pays doctors and hospitals. Health professionals will paid according to quality measures rather than volume of services. Payments for things like joint replacements and bypasses would be bundled, with the risk of mistakes falling onto those providing the care.

Expect him to push harder for doctors and hospitals to implement electronic medical records that travel with the patient.
Expect many, many groups to push back.

To see where Berwick may take Medicare, you need only look at where he has been.
Here are some excerpts from Berwick’s writings and remarks in recent years:

Feb. 4, 2010
Berwick co-authored a piece in the New England Journal of Medicine: “Cottage Industry to Postindustrial Care — The Revolution in Health Care Delivery”

“…Our current health care system is essentially a cottage industry of nonintegrated, dedicated artisans who eschew standardization. Services are often highly variable, performance is largely unmeasured, care is customized to individual patients, and standardized processes are regarded skeptically….”
“…Three key steps — wise standardization, meaningful measurement, and respectful reporting — have transformed other industries, and we believe they can help health care as well.”
“…Rather than undermining health care, public reporting on the performance of standardized care processes and outcomes will be the key to converting our isolated cottages into integrated, continually improving communities.”

And in May 2009, he penned a very personal essay on what it will take for medicine to become patient-centered, in the journal Health Affairs.

“What chills my bones is indignity. It is the loss of influence on what happens to me. It is the image of myself in a hospital gown, homogenized, anonymous, powerless, no longer myself. It is the sound of a young nurse calling me, “Donald,” which is a name I never use—it’s “Don,” or, for him or her, “Dr. Berwick.” It is the voice of the doctor saying, “We think…,” instead of, “I think…,” and thereby placing that small verbal wedge between himself as a person and myself as a person. It is the clerk who tells my wife to leave my room, or me to leave hers, without asking if we want to be apart. Last month, a close friend called a clinic for her mammogram report and was told, “You have to come here; we don’t give that information out on the telephone.” She said, “It’s OK, you can tell me.” They said, “No, we can’t do that.” Of course, they “can” do that. They choose not to, and their choice trumps hers: period. That’s what scares me: to be made helpless before my time, to be made ignorant when I want to know, to be made to sit when I wish to stand, to be alone when I need to hold my wife’s hand, to eat what I do not wish to eat, to be named what I do not wish to be named, to be told when I wish to be asked, to be awoken when I wish to sleep.”

But what will disconcert the conservatives most is an essay he wrote for the British Medical Journal in July 2008 on the 60th anniversary of the National Health Service.

“Cynics beware, I am romantic about the National Health Service; I love it. All I need to do to rediscover the romance is to look at health care in my own country….
Because you use a nation as the scale and taxation as the funding, the NHS is highly political. It is a stage for the polarising debates of modern social theory: debates between market theorists and social planning; enlightenment science and post-modern sceptics of science; utilitarianism and individualism; the premise that we are all responsible for each other and the premise that we are each responsible for ourselves; those for whom government is a source of hope and those for whom government is hopeless.
But, even in these debates, you are unified by your nation’s promise to make health care a human right.”

On July, 6, The New York Times’ Robert Pear reported that Berwick would be put into the top job at CMS, the agency that administers Medicare, via a “recess appointment,” a neat procedural trick that would put Berwick into the key job without a Senate hearing, to save Berwick, a fan of the British national health system, from becoming a focus for conservatives.

But that would have meant Berwick’s appointment would expire in late 2011.

Having the Senate sign off on his appointment now may protect his position into the future, which could be critical to implementing the health transformation as passed. And so the debate continues.